California Holds Second School MAA Stakeholder Forum in Sacramento

Last week, California’s Department of Health Care Services (DHCS) held their second Stakeholder Forum for the School-based Medi-Cal Administrative Activities (SMAA) program  in Sacramento. The meeting was well attended, both in-person and by telephone, with representatives from school districts, LECs and LGAs, vendors, and professional organizations.

Below is a brief summary of topics covered during the Forum. It’s important to remember that while these meetings can shed light on Department opinion or stance on a given issue, nothing should be taken as official policy until published by the Department.

RMTS Extension Request. DHCS has not received an official approval or denial from CMS regarding the request to delay RMTS implementation one year, until July 1, 2015. DHCS representatives stated that CMS continues to push for implementation this year, on the previously agreed upon date of July 1, 2014, and that any delay of RMTS will also result in a delay of payment for interim claiming invoices, starting with FY 2013/14.

Deferral-Release Process. DHCS has started receiving Reasonableness Test Criteria (RTC) packets, the paperwork that school districts must submit and have approved to receive back-payment on deferred invoices. The Department reported receiving 232 adjusted invoices out of 4,500 total outstanding deferred invoices and estimate their current turnaround for processing completed RTC packets is 6 weeks (noting that reviews will take longer if DHCS Analysts need additional information from districts or LEC/LGAs to complete their review). According to this schedule, which could change as DHCS receives more RTC packets, it is possible that some school districts could start seeing reimbursements by late May.

SMAA RMTS Plan. A final plan for RMTS has not yet been approved by CMS. In response to a question raised by a Forum attendee, DHCS noted that while some changes have been made to the latest draft plan on their website (for example: allowing LECs and LGAs to contract with a vendor for RMTS moment coding), these changes have not been posted because DHCS has not yet submitted the updated plan to CMS.

Stakeholder Proposals. DHCS submitted several issues to CMS that had been raised by stakeholders at the first Forum. While most were rejected or raised concerns from CMS, the federal agency did indicate a willingness to explore ways to include some form of quality control review of coded RMTS moments by the school districts. The Department also published a new SMAA appeals process, PPL 14-006, which outlines the process by which a school district, LEC, or LGA can appeal decisions directly to DHCS [updated 4/7/14].

Following the March 24 Forum, DHCS pulled down their most recent SMAA Weekly Updates (#8 and #9) for revision. It seems likely that this is in response to specific issues raised and addressed during the meeting.

The next Stakeholder Forum has not yet been announced, but the Department stated that they intend to hold the forums every other month.


Read more

DHCS ‘What’s New’ SMAA website page… 

Current RMTS Draft Plan on DHCS’s website…

Visit Paradigm’s Issue Analysis page on RMTS…

Visit Paradigm’s Issue Analysis page on the SMAA Deferral…